2009年1月21日 星期三

OHCA 低溫處置不見長期療效？

The impact of therapeutic hypothermia on neurological function and quality of life after cardiac arrest

AimsTo assess the impact of therapeutic hypothermia on cognitive function and quality of life in comatose survivors of out of Hospital Cardiac arrest (OHCA).

MethodsWe prospectively studied comatose survivors of OHCA consecutively admitted in a 4-year period. Therapeutic hypothermia was implemented in the last 2-year period, intervention period (n = 79), and this group was compared to patients admitted the 2 previous years, control period (n = 77). We assessed Cerebral Performance Category (CPC), survival, Mini Mental State Examination (MMSE) and self-rated quality of life (SF-36) 6 months after OHCA in the subgroup with VF/VT as initial rhythm.

ResultsCPC in patients alive at hospital discharge was significantly better in the intervention period with a CPC of 1–2 in 97% vs. 71% in the control period, p = 0.003, corresponding to an adjusted odds ratio of a favourable cerebral outcome of 17, p = 0.01. No significant differences were found in long-term survival (57% vs. 56% alive at 30 months), MMSE, or SF-36. Therapeutic hypothermia (hazard ratio: 0.15, p = 0.007) and bystander CPR (hazard ratio 0.19, p = 0.002) were significantly related to survival in the intervention period.

ConclusionCPC at discharge from hospital was significantly improved following implementation of therapeutic hypothermia in comatose patients resuscitated from OCHA with VF/VT. However, significant improvement in survival, cognitive status or quality of life could not be detected at long-term follow-up.